Revised National TB Control

Programme (RNTCP)
PPM DOTS in RNTCP
Central TB Division,
Ministry of Health and Family Welfare
Government of ndia
Problem of TB in ndia
Incidence of TB disease: 1.8 million new TB cases annually (0.8
million new infectious cases)
PrevaIence of TB disease: 3.8 million bacteriologically positive
(2000)
Deaths: about 370,000 deaths due to TB each year
TB/HIV: ~2.5 million people with HV;
About 5% of TB patients estimated to be HV positive
MDR-TB in new TB cases >3%
Substantial socio- economic impact
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nnuaIized New Smear-Positive Case Detection Rate
and Treatment Success Rate in DOTS areas, 1999-2007
Population projected from 2001 census
Estimated no. of NSP cases - 75/100,000 population per year (based on recent ART report)
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nnuaIised New S+ve CDR Success rate
Year Milestones
1993 RNTCP started in pilot districts
1995 PPM model started in Hyderabad (NGO Hospital)
1997 National consensus conIerence oI Medical Colleges
2000-2003 PPM models in Delhi, Kannur, Kollam, Mumbai, Tea-gardens oI north-east
2001 Schemes Ior involvement oI NGOs in RNTCP published
2002 Schemes Ior involvement oI Private Practitioners (PP) in RNTCP published
2002 National workshop oI medical colleges: seven nodal centres identiIied
2002-2003 PPM activities initiated in all the RNTCP states
2003 IntensiIied PPM scaling up began in 12 urban sites
2003-2004 Initiatives to involve other Government Departments, Public Sector Undertakings
2004 Declaration by national IMA to support RNTCP
2005 IAP guidelines, Urban DOTS GFATM projects, expansion oI intensiIied PPM
2007 17,000 private practitioners, 250 Medical colleges, 2500 NGOs and 150 corporate
houses involved
RNTCP: Major milestones in PPM DOTS
The New Global Strategy to Stop
TB
PubIic-Private Mix (PPM) DOTS
PPM DOTS is a strategy to diagnose and treat
TB patients reporting to all sectors of health care
under DOTS strategy through a mix of different
types of health care service providers
PPM DOTS has been defined by WHO as
'strategies that Iink aII entities within the
private and pubIic sectors (incIuding heaIth
providers in other governmentaI ministries)
to the nationaI TB programme for DOTS
expansion'.
STC
Focuses on TB care as
well as controI
Supported by a broad
international consensus
Presents an evidence
base
Applies to all
practitioners and is
more relevant to the
private sector
Serves as a focus of a
global campaign to
improve TB care and
control
Health care providers in ndia
Ministry of health Other Ministries Non-Government
Directorate of
health (RNTCP,
primary health
care)
Directorate of
Medical education
(Medical Colleges)
Railways
Employees State
nsurance
Mining
Coal
Steel
Ports
Prisons
Armed forces
NGOs
Private hospitals
Corporate
industries
Private
practitioners
Traditional
practitioners
PubIic sector
Provides
training/supervision
drugs/supplies/honorariu
m
Notifies TB cases
Retrieves patients who
interrupt treatment
Other sectors
Refer/Diagnose/treat TB cases
nform public sector about
TB patients/interruption of treatment
Follow
RNTCP guidelines
NGO/PP guidelines
Roles of public and private sectors in
PPM DOTS
Achievements in PPM
3000 NGOs involved under RNTCP
~17,000 Pvt. practitioners involved under RNTCP
261 Medical Colleges following DOTS strategy
150 Corporate Houses participating in RNTCP
nvolvement of professional bodies
AP involved in development of Pediatric guidelines 2005
MA actively collaborating in 167 districts/ 6 states under Rd 6
GFATM Project
ndian Medical Professional Association Coalition against TB
(MPACT) established in March 2007
Intensified PPM DOTS sites
14 intensified PPM sites
PiIot Site State
hmedabad Gujarat
BangaIore Karnataka
BhopaI Madhya
Pradesh
Bhubaneswar Orissa
Chandigarh Chandigarh
Chennai TamiI Nadu
DeIhi DeIhi
Jaipur Rajasthan
KoIkata West BengaI
Lucknow Uttar Pradesh
Patna Bihar
Pune Maharashtra
Ranchi Jharkhand
Thiruvanthapura
m
KereIa
Additional sites
14 intensified urban PPM districts( 3rd qtr 2006 to 2nd qtr 2007): Summary of
Contribution by different heaIth sectors
61.2%
61.9%
64.6%
71.8%
4.8%
3.6%
3.5%
25.7%
24.5%
18.0% 5.9%
8.6%
5.8%
7.2% 7.0%
11.5%
1.8%
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0.2%
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0.4%
5.2% 2.5%
6.5%
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90%
100%
TB suspects referred All S+ cases diagnosed New S+ cases detection No. of Patients provided
DOT
Health dept Govt, other than health Medical Colleges Corporate Private NGO
N=35658 N=49674 N=26321
N=76028
nitiatives to nvolve Medical Colleges
- Consensus conference held 1997
- Workshop of professors 2001
- Workshops in States / Medical
- Colleges from 2002 onwards
- National/Zonal/State Task MC
Forces created
- Core Committees in MCs
RAJASTHAN
ORSSA
GUJARAT
MAHARASHTRA
MADHYA PRADESH
BHAR
KARNATAKA
UTTAR
PRADESH
ANDHRA
PRADESH
JAMMU &
KASHMR
ASSAM
TAML
NADU
CHHATSGARH
PUNJAB
JHARKHAND
WEST
BENGAL
HARYANA
KERALA
UTTARANCHAL
ARUNACHAL PRADESH
HMACHAL PRADESH
MANPUR
MZORAM
MEGHALAYA
NAGALAND
TRPURA
SKKM
GOA
A&N SLANDS
D&N HAVEL
PONDCHERRY
LAKSHADWEEP
DELH
West Zone
East Zone
South Zone
North Zone
North-East Zone
ORSSA
#
#
#
#
#
#
#
Guwahati
Kolkata
Vellore
Chandigarh
AMS,Delhi
Jaipur
Mumbai
Medical Colleges as
RNTCP Nodal centres
RG Kar Medical College, Calcutta
Lokmanya Tilak Municipal Medical College and Hospital, Mumbai
SMS Medical College, Jaipur
All ndia nstitute of Medical Sciences, N Delhi
Post Graduate nstitute of Medical Education and Research, Chandigarh
Christian Medical College, Vellore, Tamil Nadu
Guwahati Medical College, Guwahati, Assam
PPM DOTS
Systematic process in involvement
Sensitization of administrators and opinion leaders
Orientation of RNTCP staff on PPM DOTS
Listing of PPM health care providers
Identification/verification of PPM facility
Sensitisation of PPM providers
Training of PPM providers
Signing of RNTCP schemes (Memorandum of Understanding-
MoU)
Start of service delivery
Tools for PPM DOTS
RNTCP guidelines
for the involvement
of NGOs (2001)
RNTCP guidelines for
the involvement of
private practitioners
(2002)
RNTCP PPM DOTS
advocacy kit (2005)
Training module for
private medical practitioners
Concise module
6 hours training
1 day X 6 hours
2 days X 3 hours
3 days X 2 hours
nvolvement of NGOs in RNTCP
There are 5 Schemes for collaboration
with NGOs
Scheme 1- Health education & community
outreach
Scheme 2- Provision of DOT
Scheme 3- n-hospital care for TB disease
Scheme 4- Microscopy & Treatment centre
Scheme 5- TB unit model
PP schemes
1. ReIerral services
2. Provision oI Directly Observed Therapy
3a. Designated Paid MC microscopy only.
3b. Designated Paid MC microscopy and
treatment.
4a. Designated MC microscopy only.
4b. Designated MC microscopy and treatment.
NGO InvoIvement in RNTCP in India
(year wise)
NGO
150
300
512
1222
2046
2263
0
500
1000
1500
2000
2500
2001 2002 2003 2004 2005 2006
PP InvoIvement in RNTCP in India
(year wise)
PP
500
900
1500
5518
10714
14674
0
2000
4000
6000
8000
10000
12000
14000
16000
2001 2002 2003 2004 2005 2006
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214
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166
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98
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State*-wise distribution of NGOs
(3
rd
qtr 2007)
Only states with more than 50 NGOs involved are presented in the slide
State*-wise distribution of PPs
(3
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qtr 2007)
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1006
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Only states with more than 150 PPs involved are presented in the slide
Challenges - PPM DOTS
Public sector related
Lack of interest / experience in dealing with other sectors
Lack of faith in the capacity of private sector
Private practitioner related
Large and unorganized private sector
Lack of faith in Public sector health programmes
Low priority for carrying out public health programmes
Patient related
Contradicting information from health sectors/systems
Lack of trust in the quality of care provided by public sector
ssues of stigma and confidentiality